Initial mechanical ventilation settings

Revision as of 11:20, 26 August 2015 by Rossdonaldson1 (talk | contribs) (Table)

Initial

  • FiO2 100% and ween down
  • Rate 8-12/min
    • consider 5-6 for asthma w/ permissive hypercapnea
  • Mode
    • A/C = defalt (most)
    • SIMV = with obstructive airway disease and an intact respiratory effort (e.g. some COPD, asthma)
    • PC = with intact respiratory effort and non-severe respiratory failure (prefered in chronic vent)
  • PEEP 0-5 mmH20
  • TV 5-8 cc/kg (eg. 500-600cc)
    • (adjust to plateau pressure <35 cmH20)
  • I/E 1:3
  • PS (pressure support) 5-8cm to overcome ET

Table

Disease TV (cc/kg) Respiratory Rate I:E PEEP FiO2
Normal lung 8 10-12 1:2 4 100%
Bronchoconstriction 6 5-8 1:4 4 100%
ARDS 6 12-20 1:2 2-15 100%
Hypovolemic 8 10-12 1:2 0-4 100%

Lung Injury Strategy

Background

  • Ok for all pts except for obstructed

Settings

  • 1. Mode
    • Assist control Volume
  • 2. Tidal Volume (lung protection)
    • Start 6-8cc/kg ideal body wt
      • Titrate down if peak pressure >30
  • 3. Inspiratory Flow Rate (comfort)
    • More comfortable if higher rather than lower
    • Start at 60-80 LPM
  • 4. Respiratory Rate (CO2)
    • Avg pt on ventilator requires 120mL/kg/min for eucapnia
    • Start 16-18 breaths/min
    • Maintain pH = 7.30-7.45
  • 5. FiO2/PEEP (O2)
    • Move in tandem to achieve:
      • SpO2 BETWEEN 88-95%
      • PaO2 BETWEEN 55-80
FiO2 0.3 0.4 0.4 0.5 0.5 0.6 0.7 0.7 0.7 0.8 0.9 0.9 0.9 1.0 1.0 1.0
PEEP 5 5 8 8 10 10 10 12 14 14 14 16 18 20 22 24

Obstruction Strategy

Background

Goal = Adequate time for expiration

Settings

  • 1. Mode
    • Assist Control Volume
  • 2. Tidal Volume
    • Vt = 8 cc/kg ideal body wt
  • 3. Inspiratory Flow Rate
    • Set at 80-100 LPM to allow more expiration time
  • 4. FiO2/PEEP
    • Titrate FiO2 to desired SpO2
    • Set PEEP 0-4
  • 5. Respiratory Rate
    • Set low - 10 BPM
    • Adjust for I:E 1:4 or 1:5
    • Permissive hypercapnia to avoid breath stacking
      • Ok as long as pH > 7.00-7.10
      • Maintain plateau pressure <30
        • If >30 go down on rate

Making Setting Changes

O2

  • PaO2 (ween to SaO2 >90% and PaO2 >60)
  • FiO2 (ween to <0.5 if poss)
  • PEEP (see ARDS schedule; if >10, should have arterial line)
    • (rule of 7s: decrease 1 FiO2 = 7 pO2)

CO2

  • PCO2
    • TV
    • Rate
  • (VE-1 x pCO2-1 = VE-2 x pCO2-2)
    • VE = minute ventilation (RR x TV)

pH

to increase pH 0.01 --> decrease pCO2 by 1

MISC (normally already set)

  • Inspiratory flow rate = 60L/min (100L/min with asthma)
  • Sensitivity = 1-2 cmH2O

See Also

Mechanical Ventilation Pages

References